US embassy cable - 03HANOI2489

UNCLAS SECTION 01 OF 03 HANOI 002489 
 
SIPDIS 
 
SENSITIVE 
 
FOR M/MED, MCCOY, HODAI, DORSEY; 
CA/OCS/ACS/EAP; 
M FOR ERIN ROONEY, NAMM; 
EAP/EX FOR COOK, KELLY, SHEPPARD, QUINN; 
EAP/BCLTV FOR JESS/DUNLAP 
BANGKOK FOR RMO KEYES 
STATE PASS HHS FOR STEIGER, BHAT, AND ELVANDER 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, TBIO, VM 
SUBJECT:  VIETNAM  - PREPARATIONS FOR POSSIBLE RETURN OF 
SARS IN VIETNAM 
 
REF: HANOI 1205 AND PREVIOUS 
 
SUMMARY 
------- 
 
1. (U) Summary.  In anticipation of the resurgence of SARS, 
Mission plans to encourage vaccinations against the flu and 
will continue to promote healthy practices in the work 
place. Consular Sections at both posts are in the process of 
a systematic updating, appraisal, and testing of our Warden 
System.  Embassy has re-established a SARS working group, is 
in direct contact with the CDC SARS working group, and is in 
contact with the EU SARS working group. On October 21 and 
22, the MOH will hold a symposium in Hanoi to make public 
its "SARS Readiness Plans." 
 
2.  (U) Screening procedures at the airports and borders for 
possible SARS cases currently are lax. Clear policies on 
medical evacuation in the event of suspected SARS remain the 
single most critical area of concern in the event of future 
cases. 
 
End Summary. 
 
 
MISSION'S PREPARATIONS 
---------------------- 
 
3.  (U) In anticipation of the resurgence of SARS in 
country, Mission will encourage all staff to participate in 
vaccinations in early October against the influenza virus in 
keeping with M/MED's recommendations.   Mission will also 
provide information on flu immunization to all American 
citizens in country to encourage vaccination. 
 
4.  (U) The Embassy and Consulate General have N95 masks and 
anti-bacterial hand sanitizer available in all restrooms and 
by all sinks.  The cleaning crews have been instructed in 
proper and frequent disinfection of all public access area 
surfaces.  Management is in frequent contact with all of the 
medical service providers in both cities. 
 
5.  The Embassy has reestablished a SARS working group whose 
role will be: to obtain information; coordinate with other 
embassies, international organizations, and GVN health 
authorities; communicate with the Department, the RMOs in 
the region, the AmCham, and with the various elements of the 
US Mission in Vietnam, including the ConGen HCMC; draft 
reporting and other cables to the Department; and draft 
notices and messages to USG employees and Americans resident 
in Vietnam.  Through the CDC Office,  Embassy is in direct 
contact with the CDC SARS working group and maintains close 
connections with WHO.  The CDC Office has also been invited 
by Vietnam's Ministry of Health (MOH) to participate in 
strategic planning for SARS.  The EU is also establishing a 
SARS working group.  It is unclear at this point whether the 
US and other non-EU countries will be invited to 
participate.  Even if the US is not invited to participate, 
Mission will remain in close contact with this working 
group. 
 
6.  (U) Embassy consular section conducted an informal, 
feedback survey to gauge Amcit satisfaction with our Warden 
Messages during the spring 2003 SARS outbreak.  The general 
feedback we received indicated that our information 
dissemination efforts during SARS were well appreciated and 
helpful.  The more information we can provide, the better, 
many said.  One Amcit wrote, "We would like to know what 
medevac plans/services are available if American citizens 
are affected by any possible SARS outbreak in the futures. 
I appreciate the WARDEN system very much." 
 
7.  (U) Another Amcit wished for more information regarding 
the authorized departure of some U.S. Embassy family 
members.  She wrote, "I did find the updates helpful as a 
citizen, and it was useful to have the embassy host the town 
meetings to listen to the community's concerns. What might 
have been explained more clearly was the rationale behind 
permitting embassy staff and dependents to leave the 
country. I realize that was more reflective of the lack of 
medical facilities than alarm about the spread of SARS in 
Vietnam, but the message wasn't conveyed in that light and 
may have caused unintended anxiety.  If it should happen 
again, the daily updates and prevention hints would again be 
useful." 
 
8.  (U) Consular Sections at both posts are in the process 
of a systematic updating, appraisal, and testing of our 
Warden System. 
 
9.  (U) The EAC will review tripwires established during the 
last outbreak to review their effectiveness should another 
outbreak occur. 
 
10.  (U) Meetings with the Overseas Security Advisory 
Councils (OSAC) and the American Chambers of Commerce in 
Hanoi and Ho Chi Minh City will be held to review lessons 
learned from the last outbreak and elicit feedback. 
 
MEDEVAC OPTIONS AND RECEIVING COUNTRIES 
 
11.  (U)  International SOS Vietnam has demonstrated a 
portable isolation unit that was used to transfer a SARS 
patient from Penghu island (off the coast of Taiwan) to 
Taipei.  SOS Clinic Manager in HCMC believes that all 
nations would receive their own citizens and that Australia 
has stated it would accept patients from any nationality 
from anywhere in the world.  However, SOS states in a press 
release of May 15, 2003, "Clearly, any movement of SARS 
patients would require the full co-operation and 
authorization of all government authorities responsible for 
Public Health and Civil Aviation in the countries concerned 
and in the countries where the aircraft would refuel or fly 
over to reach its destination. Singapore RMO reports there 
are still no nations in the region who have stated a 
willingness to accept medically transferred SARS patients" 
From the Mission perspective, it is uncertain whether this 
cooperation could be achieved. 
 
12.  Clear policies on medical evacuation in the event of 
suspected SARS remain the single most critical area of 
concern in the event of future cases. Many details are still 
unclear, including (a) whether medical evacuation will be 
generally available, particularly in the event of large 
scale epidemic; (b) possible evacuation points (e.g., will 
case-patients be medevac'ed to neighboring countries or to 
their country of origin?); (c) Which, if any, countries have 
agreed to accept case-patients? 
 
13. (U) To evacuate an American SARS case to the United 
States, refueling privileges must be granted.  As yet, we 
have not heard of a place that would grant landing rights 
for this.  Given what Mission has heard about Hawaii's 
refusal to accept an AmCit diagnosed with SARS who was being 
medevac'ed from China, we would appreciate the Departments' 
best estimate of whate states might do when asked to admit 
to their jurisdictions AmCit SARS patients or suspected 
patients or AmCits returning from countries where SARS has 
been detected. 
 
LOCAL FACILITIES READINESS 
-------------------------- 
14.  (U) A spokesman for the WHO in Hanoi told Embassy they 
are working with the (MOH) on developing and implementing 
new strategies to apply in various situations and locations, 
(e.g., border crossings, hospitals) in the event of a 
resurgence of SARS. 
 
15.  (U) On October 21 and 22, the MOH will hold a symposium 
in Hanoi to make public its "SARS Readiness Plans."  The 
general feeling in the international medical community is 
that the GVN would handle any future outbreaks of SARS in a 
similar fashion as they did the last one.   Suspected SARS 
patients would be required by the government to go to one of 
the designated isolation hospitals.  The National Institute 
of Clinical Research on Tropical Medicine (NICRTM) at the 
Bach Mai National Hospital in Hanoi, and the Tropical 
Medical Hospital in Cholon District in HCMC, were the 
isolation hospitals in the 2003 epidemic earlier this year. 
Both hospitals are operating as usual, and currently remain 
the MOH-designated hospitals for quarantine and treatment of 
probable SARS cases. However, there are reports that Hanoi 
is building an isolation facility outside the city limits. 
More will be reported on this as details become available. 
 
16.  (U) The Hanoi French Hospital (only recently reopened 
after closure during the first SARS epidemic), the Franco- 
Vietnamese Hospital in HCMC, the International SOS clinics 
in both cities, and the Hanoi and HCMC Family Medical 
Practice have protocols in place that would prevent 
potential SARS patients from infecting other patients at the 
clinics (e.g questionnaires, isolation rooms, etc). 
 
17.  (U) Border control: The Vietnamese Government purchased 
thermal imaging machines for international airports and 
instituted a health check questionnaire.  However, how 
systematically these machines and questionnaires are being 
used is erratic. It has been noted that these are not always 
in use in Ho Chi Minh City's Tan Son Nhat airport or Hanoi's 
Noi Bai airport.  The health questionnaire is still issued 
to incoming passengers but is not required for entry into 
HCMC, while it is usually required for entry into Hanoi. 
One must presume that in the case of a new outbreak these 
measures would be strictly enforced; however, they would not 
stop the initial entry of a SARS carrier into the country. 
Vietnam has re-opened borders with China and in late 
September, Vietnam Airlines will resume SARS-suspended 
flights to Guangzhou.  Other SARS-suspended flights were 
resumed earlier this summer and most routes are operating at 
normal or near normal "pre-SARS" frequency. 
 
PORTER